Medical surgical issues

Some certain medical surgical conditions can be very tormenting in different ways and only those afflicted can truly, honestly and adequately describe what they are going through.

For some of these conditions, patients think of life only as a matter of one day at a time. A patient may have acquired some knowledge about his condition with the passage of time, through such avenues as Radio, Television, Newspapers, the experience of people they knew or were told about , or by going through the internet. One important issue is how much information a man with a surgical condition has on his condition and his understanding and perception of possible disease outcome (probability of dying or recovering from it). Some how at a point in time, an individual with a medical surgical problem will have to face reality and accept he does have a problem that will require him to make decisions and this acceptance which may or may not be followed by decision making will in turn be influenced by several factors. In many instances, the outcome of a condition will be positively or negatively affected by decisions made by the patient or family members based on peculiar circumstances, by what they were told or actually knew.

Take the case of fifty year old Nigerian who came to a Tertiary health facility with what was diagnosed as Epileptia partialis continua, or in common language continuous partial epilepsy , a condition in which tonic clonic seizure attacks, starting from the toes went through the foot, the ankle joint, leg, the knee joint, thigh region, the hip joint, trunk, the shoulder joint, the arm, elbow joint, fore arm, the wrist joint in that order, and terminated in the fingers. Every ten to twenty minutes while it lasted, this patient went through this cycle. It took a lot of talking and persuading to convince him and members of his family ,what he had was purely a medical problem. We came to understand that he had had a Goniotomy, an operation to remove accumulated fluid in the eye ball that had caused glaucoma (hypertension of the eye globe). He had gone back to the village but could not communicate with his Surgeon, a well known ConsultantOphthalmologist, and so against medical advice placed himself on herbal medicines. Infection probabably passed by way of the ophthalmic veins into the orbit and since the eyes are actually part and parcel of the brain, spread therein to form abscess, a space occupying lesion in the Brain. The family had concluded that a very strong evil spirit was tormenting him , but we stood by our impression, opted for drug treatment first but with the possibility of surgery if our efforts failed, and the result we got was like a miracle exactly eight days from when he presented.

Conditions like like Leucomalacia, pockets of fluid collection in the brain will present in ways slightly different from what has just been described, but no less frightening. These are not common but do exist in our environment.There are other common conditions that are relentlessly tormenting individuals and about which additional problems can arise from making wrong decisions either concerning treatment options, whether to go for surgery, or in the post op period

The issue of money is very important . For rural dwellers and others strongly inclined to the spiritual and paranormal belief systems, contact with Hospital type health care providers stops once the news drops, they have conditions that will require surgery. This is partly because it is difficult to separate surgery and money in a situation where ordinary people are not captured in the National Health Insurance Scheme

Most people in the villages get health information from neighbors and family members, including those least informed to provide medical advice that will be useful . Even for patients living in towns and cities, who have access to and are adequately making use of available health care facilities, accepting surgery does not come without delay at various points of the decision making process. One major issue most patients, their relations and significant others often wrestle with is the uncertainty associated with surgery of any kind, often prompting them to ask why even in the best of hands, and the best equipment in the world, some surgical interventions are fraught with risks and complications quite out of proportion with the speed with which they are performed. Some have argued that treatment options for some of these conditions seem to be worse than the diseases, they are meant to address particularly in Nigeria. Physicians and Surgeons here in Nigeria have countered quite reasonably that things only go wrong when patients wait until their conditions have reached advanced stages and even then go to the wrong places to seek solutions. They also contend that in places where things are done properly, the skills, experience and professional thoroughness of a surgeon should guide his choice for a particular surgical procedure, provided the facilities are there.Most of these surgeons who have had the privilege of additional specialist training outside the country can recall many instances where they have had to use their surgical technical ingenuity to construct whole or pieces of medical surgical devices, either in the operating theatre or intensive care unit in order to save lives

It is not difficult to understand why there is fear and uncertainty concerning surgery here,

Facilities and equipment like cardiac monitors are available only in cities and then are beyond the reach of 90% of the population. Beyond that people talk about minor and major surgery only in academic terms ; the distinction is blurred, when practical encounters are examined.

Surgery may be performed for different reasons, and could be done at times elected or as emergencies as in ruptured ectopic pregnancy, broken limbs and organ lacerations following Road traffic accidents, for obstructed labor to save lives of baby and mother in an early stage of breast cancer to save patient from dying later from advanced form of the disease, as a repair job by Burns and plastic or Maxillofacial surgeons when they handle cases of cleft lip and palate to enable child smile and talk and to improve quality of life , as liposuction/stomach reduction surgery to treat obesity or breast implant placement.